Purpose: To report the availability of optical coherence tomography angiography (OCTA) when diagnosing type 1 and type 2 choroidal neovascularization (CNV) associated with age-related macular degeneration. Methods: We conducted a retrospective chart review of 63 eyes of 59 patients who visited the outpatient clinic from April 2018 to January 2020 with treatment-naïve type 1/2 CNV associated with age-related macular degeneration. The CNV was diagnosed through fluorescein angiography and indocyanine green angiography on the appearance of hyperfluorescence and leakage at the late phase. The CNV type was classified by location using OCT. These results were compared with those of automatic and manual segmentations via OCTA. Results: Of the 63 eyes, 45 eyes showed type 1 CNV and 18 eyes indicated type 2 CNV. Using the automatic segmented display of OCTA, type 1 CNV was identified in 29 of 45 eyes and type 2 CNV was confirmed in 17 of 18 eyes. In addition, when manual segmentation was performed, type 1 CNV was found in 41 of 45 eyes and type 2 CNV in 18 of 18 eyes. The sensitivity of diagnosis of type 1 CNV using only automatic segmentation in OCTA was 64.44%; the sensitivity increased to 91.11% when additional manual segmentation was performed (p < 0.001). For type 2 CNV, the sensitivity was 94.44% using automatic segmentation in OCTA and 100% with additional manual segmentation (p = 1.000). Conclusions Automatic segmentation of OCTA and OCT analyses enabled diagnosis of type 1 and type 2 CNV associated with age-related macular degeneration. The diagnosis accuracy or type 1 CNV improved significantly when manual segmentation was added.

Purpose: To report the availability of optical coherence tomography angiography (OCTA) when diagnosing type 1 and type 2 choroidal neovascularization (CNV) associated with age-related macular degeneration. Methods: We conducted a retrospective chart review of 63 eyes of 59 patients who visited the outpatient clinic from April 2018 to January 2020 with treatment-naïve type 1/2 CNV associated with age-related macular degeneration. The CNV was diagnosed through fluorescein angiography and indocyanine green angiography on the appearance of hyperfluorescence and leakage at the late phase. The CNV type was classified by location using OCT. These results were compared with those of automatic and manual segmentations via OCTA. Results: Of the 63 eyes, 45 eyes showed type 1 CNV and 18 eyes indicated type 2 CNV. Using the automatic segmented display of OCTA, type 1 CNV was identified in 29 of 45 eyes and type 2 CNV was confirmed in 17 of 18 eyes. In addition, when manual segmentation was performed, type 1 CNV was found in 41 of 45 eyes and type 2 CNV in 18 of 18 eyes. The sensitivity of diagnosis of type 1 CNV using only automatic segmentation in OCTA was 64.44%; the sensitivity increased to 91.11% when additional manual segmentation was performed (p < 0.001). For type 2 CNV, the sensitivity was 94.44% using automatic segmentation in OCTA and 100% with additional manual segmentation (p = 1.000). Conclusions Automatic segmentation of OCTA and OCT analyses enabled diagnosis of type 1 and type 2 CNV associated with age-related macular degeneration. The diagnosis accuracy or type 1 CNV improved significantly when manual segmentation was added.

BACKGROUND: A noninvasive method for estimating cardiac output was tested in dogs. The technique is based on a differential CO2 Fick equation applied during normal ventilation and 50 seconds of partial rebreathing using additional dead space. We compared the cardiac output measured by the CO2 rebreathing method vs. the thermodilution technique. METHODS: Seven mongrel-dogs (24.6 +/- 0.4 kg) were studied, anesthesia was induced and maintained with a pentobarbital 25 mg/kg IV bolus injection followed by an infusion of 5 mg/kg/h. Mechanical ventilation was accomplished with a Servo 900C ventilator with FiO2 0.6 to maintain normocarbia. A fiberoptic pulmonary artery catheter was introduced via an external jugular vein for continuous monitoring of the cardiac output by the thermodilution method. Also cardiac output was measured by using partial CO2 rebreathing method. A continuous infusion of 0.5% bupivacaine was started at 0.5 mg/kg/min via the venous infusion port of the pulmonary catheter. Bupivacaine was infused continuously until mean arterial pressure decreased to 60 mmHg or less for at least 5 seconds. RESULTS: The total measured cardiac outputs (n = 72) were distributed over the range of 1.03-7.72 L/min by thermodilution method and 1.6-7.3 L/min by CO2 rebreathing. The correlation coefficients between both cardiac outputs was 0.6, the mean difference was 0.27 +/- 0.81 L/min. CONCLUSIONS: The cardiac output measured by CO2 rebreathing method was well correlated with cardiac output by thermodilution method.
Anesthesia ; Animals ; Arterial Pressure ; Bupivacaine ; Cardiac Output* ; Catheters ; Dogs ; Jugular Veins ; Pentobarbital ; Pulmonary Artery ; Respiration, Artificial ; Thermodilution* ; Ventilation ; Ventilators, Mechanical

BACKGROUND: Propofol and remifentanil are usually co-administered and have shown synergistic effect for anesthesia. However, the synergistic effect of the two drugs on hypnosis measured by bispectral index (BIS) was controversial in previous studies. The aim of this study was to identify the interaction of propofol and remifentanil on BIS and the optimal dose combinations for hypnosis under 66% N2O during surgery. METHODS: Patients (age 55-75 and American Society of Anesthesiologists [ASA] 1-2) undergoing gastrectomy were enrolled in this study. Propofol and remifentanil were co-administered incrementally at 1 : 1 potent ratio (the P1R1 group), at 1 : 2 potent ratio (the P1R2 group), or at 2 : 1 potent ratio (the P2R1 group) using effect site target-controlled infusion and BIS was measured. 66% N2O was concomitantly administered to all groups. The dose-effect curves, the 90% effective dose (EC90) for adequate hypnosis (BIS 40), isobolograms and combination index were obtained by Calcusyn program (Biosoft) to reveal the interaction of propofol and remifentanil. RESULTS: The P2R1 group showed synergistic action on BIS. However, the other groups needed larger amount of each drug than the doses of additive action. The EC90 of the P2R1 group was propofol, 3.34 microg/ml and remifentanil, 2.41 ng/ml under 66% of N2O. CONCLUSIONS: Propofol dominant co-administration is needed for dose reduction in BIS guided hypnosis.
Anesthesia ; Gastrectomy ; Humans ; Hypnosis ; Piperidines ; Propofol

Obesity is a critical target for public health interventions worldwide. There are many causes of obesity, and the importance of the gut microbiota in its pathogenesis has recently been recognized. The composition and function of the gut microbiota play a role in obesity and metabolic disease, yet the underlying mechanisms are unclear. Advances in our understanding of the link between obesity and the gut microbiota have suggested the potential of its manipulation for treating obesity. In this review, we summarize current knowledge of the interactions between the gut microbiota and obesity as well as the therapeutic potential of its modulation.
Gastrointestinal Microbiome ; Metabolic Diseases ; Obesity ; Public Health

Obesity is a critical target for public health interventions worldwide. There are many causes of obesity, and the importance of the gut microbiota in its pathogenesis has recently been recognized. The composition and function of the gut microbiota play a role in obesity and metabolic disease, yet the underlying mechanisms are unclear. Advances in our understanding of the link between obesity and the gut microbiota have suggested the potential of its manipulation for treating obesity. In this review, we summarize current knowledge of the interactions between the gut microbiota and obesity as well as the therapeutic potential of its modulation.

BACKGROUND: Bupivacaine induces cardiac depression, which is resistant to treatment. Therefore early recognition of its development is important so that the injection of bupivacaine can be discontinued promptly. We compared the efficacy of continuous mixed venous oxygen saturation (cSvO2) monitoring with that of the mean arterial blood pressure (MBP) monitoring in terms of the prediction of cardiac output (CO) changes in anesthetized dogs with bupivacaine-induced cardiovascular depression. METHODS: Bupivacaine was infused to pentobarbital-anesthetized mongrel dogs (n = 8) at a rate of 0.5 mg/kg/min until the MBP decreased to 40 mmHg or less (end of bupivacaine infusion; BIE). We defined the early period as the interval from baseline till 30 minutes after the bupivacaine infusion and the late period as that after the 30 minutes till BIE. We monitored cSvO2 with a fiberoptic pulmonary artery catheter. The MBP and CO were measured every ten minutes after the initiation of the bupivacaine infusion. Arterial blood gas analysis, mixed venous gas analysis, measurement of serum electrolyte concentrations and serum bupivacaine concentrations were performed simultaneously. The relationship between CO versus cSvO2 or versus MBP was compared retrospectively by regression analysis. RESULTS: The Pearson's correlation coefficients between CO and cSvO2 were 0.782 (r2 = 0.6111, P < 0.01) in the early period and 0.824 (r2 = 0.6790, P < 0.01) in the late period. The correlation coefficients between CO and MBP were 0.019 (r2 = 0.0003, P > 0.05) in the early period and 0.799 (r2 = 0.6381, P < 0.01) in the late period. CONCLUSIONS: cSvO2 is superior to MBP for the prediction of CO changes in bupivacaine-induced cardiac depression in dogs, especially in the early period. We might expect a profound reduction of CO when MBP begins to decrease in the late period.
Anesthesia ; Animals ; Arterial Pressure* ; Blood Gas Analysis ; Blood Pressure ; Bupivacaine ; Cardiac Output ; Catheters ; Depression* ; Dogs* ; Oxygen* ; Pulmonary Artery ; Retrospective Studies

Although it is known that hypothyroidism can cause cardiac dysfunction, it is very hard to find a case report on sudden death due to hypothyroidism. There are only two reported cases on medline; one is about a 15-year-old girl who died suddenly of Hashimoto's thyroiditis and the other is about a 31-year-old man who also died suddenly of hypothyroidism associated with chronic lymphocytic thyroiditis. Recently we found a young woman who unexpectedly died while she was sleeping. She was diagnosed as hypothyroidism when she went to hospital about a month before she died. At autopsy there were roughly four abnormal findings; Hashimoto's thyroiditis, mild chronic active hepatitis, diverticulosis and accessory spleen. Trace of chlorpheniramine was detected in gastric remains and blood alcohol level was 0.37 percent. To our knowledge, this is the first case reporting sudden and unexpected natural death associated with hypothyroidism in Korea.
Adolescent ; Adult ; Autopsy ; Chlorpheniramine ; Death, Sudden* ; Diverticulum ; Female ; Hashimoto Disease ; Hepatitis, Chronic ; Humans ; Hypothyroidism* ; Korea ; Spleen ; Thyroid Gland ; Thyroiditis

Although it is known that hypothyroidism can cause cardiac dysfunction, it is very hard to find a case report on sudden death due to hypothyroidism. There are only two reported cases on medline; one is about a 15-year-old girl who died suddenly of Hashimoto's thyroiditis and the other is about a 31-year-old man who also died suddenly of hypothyroidism associated with chronic lymphocytic thyroiditis. Recently we found a young woman who unexpectedly died while she was sleeping. She was diagnosed as hypothyroidism when she went to hospital about a month before she died. At autopsy there were roughly four abnormal findings; Hashimoto's thyroiditis, mild chronic active hepatitis, diverticulosis and accessory spleen. Trace of chlorpheniramine was detected in gastric remains and blood alcohol level was 0.37 percent. To our knowledge, this is the first case reporting sudden and unexpected natural death associated with hypothyroidism in Korea.
Adolescent ; Adult ; Autopsy ; Chlorpheniramine ; Death, Sudden* ; Diverticulum ; Female ; Hashimoto Disease ; Hepatitis, Chronic ; Humans ; Hypothyroidism* ; Korea ; Spleen ; Thyroid Gland ; Thyroiditis